Priscilla T. Ryder

Achieving Pharmacy-Based Public Health: A Call for Public Health Engagement

©2013 Association of Schools of Public Health The evolution of pharmacy practice in the last 15 years has created expanded public health access. Community pharmacies now provide a range of public health services with promising improvements in health access and outcomes. The observed practice changes call our attention to systemic issues that remain in need of collective attention. As we strengthen our intersectoral public health system, we must focus on the pharmacy-public health partnership and establish collaborative policy and research agendas to guide this system change for maximum public health impact. Our collective effort to assure the health of communities depends upon our seeing opportunities across systems and sectors, and upon our success in shifting the policy environment to allow health system flexibility.

We Can Do More Than Just Sell the Test: Pharmacist Perspectives About Over-the-Counter Rapid HIV Tests

Pharmacist attitudes about the over-the-counter (OTC) sale of HIV rapid tests in pharmacies were explored through interviews conducted among 17 licensed community pharmacists in a Midwestern, moderate HIV incidence state between May and September 2012. Participants recognized that OTC rapid HIV tests would increase the number of people aware of their HIV status. Concerns included linkage to care and results consultation for those who test HIV-positive. Point of sale was identified as an opportunity for consultation about the test and to establish a relationship for future discussion about results and linkage to care. Pharmacists could provide initial test consultation or information, and consultation about the test results in order to provide post diagnosis support and facilitate linkage to care.ResumenLas actitudes de los farmacéuticos sobre el over-the-counter (OTC) venta de las pruebas rápidas del VIH en farmacias se exploró a través de entrevistas entre los 17 farmacéuticos comunitarios con licencia en un estado del Midwestern en Estados Unidos, moderado incidencia del VIH entre Mayo y Septiembre de 2012. Los participantes reconocieron que OTC pruebas rápidas de VIH aumentaría el número de personas que conocen su estado serológico. Las preocupaciones incluyen la vinculación con cuidado y consulta los resultados para los que el resultado es VIH-positivo. Point of sale de venta fue identificado como una oportunidad de consulta sobre la prueba y establecer una relación para un discussion futuro sobre los resultados y la vinculación a la atención. Los farmacéuticos podría ofrecer consulta inicial de prueba o información y consulta sobre los resultados de la prueba con el fin de ofrecer apoyo después de diagnóstico y facilitar la vinculación a la atención.

Preferences of Gay and Bisexual Men for Pharmacy-Based HIV Testing and Over-the-Counter HIV Tests

A 2013 study among 169 Indiana men aged 18-45 who have sex with men assessed the acceptability of and preferences for pharmacy-based and over-the-counter (OTC) HIV testing. Rural men in general and men who did not know their HIV status were more likely to purchase an OTC HIV test. Men who did not know their HIV status also preferred an OTC HIV test to pharmacy-based testing. Pharmacies should enhance information around the sale of OTC HIV tests, particularly in rural areas. Information should include test results, opportunities for consultation, and linkage to care.

Predicting pharmacy syringe sales to people who inject drugs: Policy, practice and perceptions

Background: Pharmacies have much to contribute to the health of people who inject drugs (PWID) and to community efforts in HIV and hepatitis C (HCV) prevention through syringe access. However, little is known about what predicts pharmacy syringe sales without a prescription. Objective: To identify factors predicting pharmacy syringes sales to PWID. Methods: A hybrid staggered online survey of 298 Indiana community pharmacists occurred from July-September 2016 measuring pharmacy policy, practice, and pharmacist perceptions about syringe sales to PWID. Separate bivariate logistical regressions were followed by multivariable logistic regression to predict pharmacy syringe sales and pharmacist comfort dispensing syringes to PWID. Results: Half (50.5%) of Indiana pharmacies sold syringes without a prescription to PWID. Pharmacy syringe sales was strongly associated with pharmacist supportive beliefs about syringe access by PWID and their comfort level selling syringes to PWID. Notably, pharmacies located in communities with high rates of opioid overdose mortality were 56% less likely to sell syringes without a prescription than those in communities with lower rates. Pharmacist comfort dispensing syringes was associated with being male, working at a pharmacy that sold syringes to PWID and one that stocked naloxone, having been asked about syringe access by medical providers, and agreement that PWID should be able to buy syringes without a prescription. Conclusions: As communities with high rates of opioid overdose mortality were less likely to have pharmacies that dispensed syringes to PWID, a concerted effort with these communities and their pharmacies should be made to understand opportunities to increase syringe access. Future studies should explore nuances between theoretical support for syringe access by PWID without a prescription and actual dispensing behaviors. Addressing potential policy conflicts and offering continuing education on non-prescription syringe distribution for pharmacists may improve comfort distributing syringes to PWID, and therefore increase pharmacy syringe sales.

Predicting pharmacy naloxone stocking and dispensing following a statewide standing order, Indiana 2016

Background: While naloxone, the overdose reversal medication, has been available for decades, factors associated with its availability through pharmacies remain unclear. Studies suggest that policy and pharmacist beliefs may impact availability. Indiana passed a standing order law for naloxone in 2015 to increase access to naloxone. Objective: To identify factors associated with community pharmacy naloxone stocking and dispensing following the enactment of a statewide naloxone standing order. Methods: A 2016 cross-sectional census of Indiana community pharmacists was conducted following a naloxone standing order. Community, pharmacy, and pharmacist characteristics, and pharmacist attitudes about naloxone dispensing, access, and perceptions of the standing order were measured. Modified Poisson and binary logistic regression models attempted to predict naloxone stocking and dispensing, respectively. Results: Over half (58.1%) of pharmacies stocked naloxone, yet 23.6% of pharmacists dispensed it. Most (72.5%) pharmacists believed the standing order would increase naloxone stocking, and 66.5% believed it would increase dispensing. Chain pharmacies were 3.2 times as likely to stock naloxone. Naloxone stocking was 1.6 times as likely in pharmacies with more than one full-time pharmacist. Pharmacies where pharmacists received naloxone continuing education in the past two years were 1.3 times as likely to stock naloxone. The attempted dispensing model yielded no improvement over the constant-only model. Conclusions: Pharmacies with larger capacity took advantage of the naloxone standing order. Predictors of pharmacist naloxone dispensing should continue to be explored to maximize naloxone access.

P5.026 More Than Just Selling the Test: Pharmacist Opinion About the Sale of Over the Counter HIV Rapid Tests

Community pharmacy sale of over-the-counter (OTC) rapid HIV tests may provide an important extension of the public health system. U.S. pharmacy practise has expanded to include several public health services; however, nothing is known about pharmacist attitudes about OTC sale of HIV tests and related consultation opportunities. Methods This study identifies and explores the views of pharmacists regarding the sale of OTC rapid HIV tests. Exploratory interviews were conducted among a sample of 17 licenced community pharmacists in a Midwestern U.S. state with moderate HIV incidence. 30-minute interviews were conducted in person or by telephone between May and September 2012. Interviews were recorded and transcribed for a priori and open coding. Three investigators independently coded transcripts to assure interrator reliability. Findings Pharmacists had positive attitudes about the OTC rapid HIV test, as testing would likely result in more people learning their HIV status. Participants felt that the pharmacy role should not be limited to test kit sale. Pharmacists framed their role as health consultants focused specifically on results consultation and linkage to treatment. Point of sale was identified as the opportunity for consultation about the HIV test and to establish a relationship for future discussion about results and linkage to care. Conclusion Pharmacist consultation at point of OTC HIV test sale provides an important opportunity to increase options for linkage to HIV care. Future studies should investigate pharmacist opinion and attitudes about the OTC sale of rapid HIV test kits among a larger and more representative sample of community pharmacists, and in states with other geographic, socio demographic and epidemiologic characteristics.